Provider Demographics
NPI:1245967728
Name:BLUE, ALICIA (FNP-BC)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:BLUE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 PRATT ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3976
Mailing Address - Country:US
Mailing Address - Phone:919-668-1002
Mailing Address - Fax:
Practice Address - Street 1:2400 PRATT ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3976
Practice Address - Country:US
Practice Address - Phone:919-668-1002
Practice Address - Fax:919-668-1091
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-04
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCBLUE-QD8H3363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner